İnferior Alveolar Sinir Transpozisyonu ile Eş zamanlı Dental İmplant Yerleştirilmesi: 4 Yıl Takipli Bir Vaka Raporu

Yıl 2021, Cilt: 8 Sayı: 3, 832 - 838, 31.12.2021

Şadiye Günpınar Mehmet Cihan Şengün Ayşe Sinem Sevinç

https://doi.org/10.15311/selcukdentj.729169

Öz

Mandibula posterior bölgede implant uygulamalarında dikkat edilmesi gereken önemli anatomik oluşumlardan biri inferior alveolar sinirdir. Diş çekimi ve uzun süreli dişsizlik durumunda alveolar kret rezorbe olmakta ve inferior alveolar sinir alveolar kret tepesine yaklaşmaktadır. Bunun sonucunda, çoğu vakada alt çene arka bölgede implantı yerleştirecek yeterli vertikal kemik mesafesi bulunamamaktadır. Sinire zarar vermeden implant yerleştirilmesi için çeşitli yöntemler geliştirilmiştir. Kısa implantların kullanılması, otojen/allojenik kemik greftlerinin kullanılmasıyla yapılan vertikal kemik ogmentasyonları, sinirin yeniden konumlandırılması (sinirin lateralizasyon veya transpozisyonu) ve distraksiyon osteogenezisi gibi yöntemler ile atrofik alt çeneye implant uygulaması yapılabilmiş ve böylece bireylerin protetik rehabilitasyonu sağlanabilmiştir. Bu seçeneklerin içerisinde sinirin yeniden pozisyonlandırılması riskli bir cerrahi gibi görülse de teknik hassasiyet ile gerçekleştirildiğinde bireyin tedavi süresini kısaltması, ikinci bir cerrahiye gerek kalmaması, ekstra bir maliyete neden olmaması ve bölgeye uzun implantların yerleştirilebilmesine olanak sağlaması gibi birçok avantajı bulunmaktadır.
Bu vaka raporunda; alt çene arka bölgede osseointegrasyonu başarısız olmuş implantın çıkarılma işlemi ve sinirin repozisyonu, ardından uzun implant yerleştirilmesi sonrası vakanın dört yıllık takibi sunulmaktadır. Bu vakanın sınırları dahilinde doğru endikasyon, hassas çalışma ve iyi bir anatomi bilgisi neticesinde sinir repozisyonu tekniği ile başarılı olunabileceği sonucuna varılabilir.

Anahtar Kelimeler

Alveolar kemik atrofisi, dental implant, inferior alveolar sinir, sinir repozisyonu, sinir transpozisyonu

Inferior Alveolar Nerve Transposition with Simultaneously Dental Implant Placement: A Case Report With 4 Years Follow-Up

Öz

Inferior alveolar nerve is one of the important anatomical landmark in implant surgery in the posterior region of the mandible. Following tooth extraction and long-term edentualism, the alveolar crest becomes resorbed and the inferior alveolar nerve gets close to the alveolar crest hill. As a result, in most cases, there is not enough vertical bone distance for to place the implant in the posterior mandibular region.
Various methods have been developed for implant placement to avoid nerve injury in the mandibular posterior region. These include, utilizing short implants, vertical augmentations using autogenous or allogenic bone grafts, repositioning the nerve (lateralization or transposition) and distraction osteogenesis. Although repositioning of the inferior alveolar nerve seems to be a hazardous surgery, this procedure has many advantages, when performed with technical precision, such as shortening the total treatment time, not requiring a second surgery, not necessitating an extra cost and enabling longer implants to be placed in the area.
In this case report, the removal of the failed implant and also the four-year follow-up of the patient with a long implant placement simultaneously with nerve reposition was presented. Within the limits of this case, it can be concluded that, successful results can be obtained with nerve reposition technique as a consequence of proper diagnosis of the patient, precise manuplation and comprehensive knowledge of the regional anatomy.

Anahtar Kelimeler

alveolar bone atrophy, dental implants, inferior alveolar nerve, nerve reposition, nerve transposition

Kaynakça

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